Medical Care Advisory Committee April 20, 2018 Responsibly - PowerPoint PPT Presentation

Medical Care Advisory Committee April 20, 2018 Responsibly providing access to quality health coverage for vulnerable Mississippians 1

State Plan Amendment (SPA) Updates SPA 17-0001 Home Health • CMS submission 8/14/2017 • CMS Request for Additional Information (RAI) Response (9/1/18) SPA 17-0004 Tribal Notification • Approved, Effective 10/1/17 SPA 17-0015 DME and Medical Supply Reimbursement • Approved, Effective 11/9/17 Responsibly providing access to quality health coverage for vulnerable Mississippians 2

SPA Updates SPA 18-0001 LTC Updates • Public Notice Posted 12/28/2017 • CMS Submission 3/22/18 SPA 18-0002 Physician UPL • Public Notice Posted 12/28/2017 • CMS Submission 3/22/18 Responsibly providing access to quality health coverage for vulnerable Mississippians 3

SPA Updates SPA 18-0003 Medicaid Administration • CMS Submission 3/30/18 SPA 18-0006 1915(i) Community Support Program (CSP) • Finalizing Public Notice • Expires 10/31/18 CHIP SPA #10 • CMS Submission 1/9/18 • RAI Issued 2/8/18 Responsibly providing access to quality health coverage for vulnerable Mississippians 4

Waiver Updates Healthier Mississippi Waiver Renewal • CMS Submission 9/28/2017 1115 Workforce Training Initiative • Completeness Letter 1/22/18 • Ongoing Discussions with CMS Intellectual Disabilities/Developmental Disabilities (ID/DD) Waiver Renewal • Expires 6/30/18 • Drafting Public Notice and Tribal Notification Responsibly providing access to quality health coverage for vulnerable Mississippians 5

Waiver Updates Assisted Living (AL) Waiver • Expires 9/30/18 • Renewal due to CMS 6/30/18 Statewide Transition Plan • Completing final draft to send to CMS Responsibly providing access to quality health coverage for vulnerable Mississippians 6

Administrative Code Updates AC 18-001 Therapeutic Leave • In Process AC 18-002 Speech Therapy • Effective 5/1/18 • Revised provider requirements for speech therapists AC 18-005 BCBA Telehealth • In Process Responsibly providing access to quality health coverage for vulnerable Mississippians 7

Administrative Code Updates AC 18-008 and 18-009 – Pharmacy Reimbursement and 340B • Revising language to mirror SPA 17-0002 AC 18-014 Search Fee • In Process AC 18-015 Program Integrity • In Process AC 18-016 Home Health • Revising language to mirror SPA 17-0001 Responsibly providing access to quality health coverage for vulnerable Mississippians 8

Administrative Code Updates AC 18-017 DME • Revising language to mirror SPA 17-0001 AC 18-018 Transportation • In Process AC 18-019 Respiratory Therapy • In Process • Adding language to mirror SPA 18-0001 Responsibly providing access to quality health coverage for vulnerable Mississippians 9

Potential Future Filings 2018 Legislative Session • Language Revision SPA 18-0009 APR-DRG Updates Under Executive Review • SPA 18-0005 Change of Ownership (CHOW) and Appeals Responsibly providing access to quality health coverage for vulnerable Mississippians 10

Physician Reimbursement Top 5 CPT Reimbursement by State Physician E&M Mississippi Florida Georgia Alabama Louisiana Arkansas Codes 99202 $62.12 $35.98 $54.57 $53.00 $42.77 $45.10 99203 $89.69 $53.55 $76.53 $78.00 $62.18 $64.90 99212 $36.02 $21.84 $29.67 $31.00 $24.83 $27.50 $36.30 99213 $61.01 $26.61 $40.70 $42.00 $41.53 $38.40 99214 $90.08 $41.46 $62.71 $67.00 $62.65 $70.05 Responsibly providing access to quality health coverage for vulnerable Mississippians 11

Physician Reimbursement Primary Care Physician (PCP) Increase Top 5 CPT Reimbursement by State Physician E&M Mississippi Florida Georgia Alabama Louisiana Arkansas Codes 99202 $69.02 *N/A $64.20 $69.27 *N/A *N/A 99203 $99.66 *N/A $93.42 $100.52 *N/A *N/A 99212 $40.02 *N/A $37.47 $40.36 *N/A *N/A 99213 $67.79 *N/A $63.14 $68.17 *N/A *N/A 99214 $100.09 *N/A $93.35 $100.91 *N/A *N/A *Florida, Louisiana, and Arkansas reported that they did not plan to continue the Affordable Care Act (ACA) primary care increase after the 100% federal funding ended on December 31, 2014. Responsibly providing access to quality health coverage for vulnerable Mississippians 12

Medicaid Enrollment by State Mississippi 1 in 4 Alabama 1 in 5 Arkansas 1 in 3 Florida 1 in 6 Georgia 1 in 6 Louisiana 1 in 3 Responsibly providing access to quality health coverage for vulnerable Mississippians 13

Adults Pregnant Children Preventive Health Screenings/Services (21+) Women (0-21)    Annual Physical Examinations  Anticipatory Guidance  Autism Screening    Bone Density Studies    Cardiovascular Screening    Cervical and Vaginal Cancer Screening    Cervical Dysplasia Screening   Colorectal Cancer Screening  Dental Assessment and Counseling   Depression Screening  Development/Behavioral Assessment  Developmental Surveillance    Diabetes Screening    Dyslipidemia Screening    Hematocrit and/or Hemoglobin    Immunizations    Influenza and Pneumonia Vaccines    Laboratory Testing    Lead Screening and Testing   Mammography  Newborn Metabolic/Hemoglobin Screening  Nutritional Assessment  Prostate Cancer Screening  Psychosocial/Behavioral Assessment    Sexually Transmitted Infection/Disease Screening   Tobacco Cessation Counseling    Tobacco Cessation Products The Division of Medicaid pays for all medically necessary services for EPSDT-eligible beneficiaries in accordance with MS Administrative Code Title 23, Part 223, without regard to    Tuberculin Testing service limitations and with prior authorization.    Vision and Glaucoma Screening Eye Exams Responsibly providing access to quality health coverage for vulnerable Mississippians 14

U.S. Department of Health & Human Services Best Practices Agency for Healthcare Research and Quality (AHRQ) authorized by • Congress to convene U.S. Preventive Services Task Force • Panel of national experts in prevention and medicine make evidence- based recommendations about clinical preventive services, screenings, counseling services, and preventive medications • All recommendations published on Task Force’s Web site and/or in peer- reviewed journal • Recommendations assigned a letter grade based on strength of evidence and balance of benefits and harms • Task Force does not consider costs of preventive service when determining recommendation Annual report to Congress • https://www.uspreventiveservicestaskforce.org/BrowseRec/Index/browse- recommendations Responsibly providing access to quality health coverage for vulnerable Mississippians 15

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